Distributor Registration

Telephone No.

Company Name

Company Owner

Company Address (Number & Street Name)

Company Address (City, Prov, & Postal Code)

Company Website

Business Number (G.S.T or H.S.T)

Industry Affiliation

Industry Affiliation No.

Person In Charge of Accounting

Accounts Payable Email

Accounts Payable Phone No.

Person In Charge of Orders

Orders Email Address

Orders Phone No.

Does your Company use Purchase Orders

Person In Charge of Sales

Sales Email Address

Sales Phone No.

Does your company belong to a buying group?

Buying Group Name

Name one supplier you currently purchase from

Brief Description of Your Business